Advice for New NICU Fellow

[Tribeca]

Hi! I'm a new NICU fellow about to start service after two weeks of boot camp/orientation/shadowing rounds. I'll be in a unit with residents, med students, and NP's. This is a new fellowship so I am new to them too. What specific things should I be doing for rounds? I'm currently in "resident mode" and know exactly what to do as a resident but not exactly sure as a fellow.

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[oldbearprofessor]

Initially your job is to be a "super senior resident" until you really get to know the system, the EHR and most importantly the staff. By the end of your first month you should have that fully in hand, have gained some measure of respect by the staff (attendings, residents, nurses and the wonderful person who empties the trash in the NICU each day), then you can take more of a teaching role. Try to always remember it is your primary job to educate, not evaluate, residents and med students, save most if not all of the pimping for the attending. Since having a fellow is new to them, you'll have to develop your role on rounds and gradually take the lead in managing resident questions about TPN, vent settings, etc. This will take time but it has to happen for you to be effective and if it doesn't, you need to talk to the attendings and make sure they understand that gradually it is your job to lead rounds while they continue to teach and make big picture decisions. Good luck and let us know how it goes!

 

[NurWollen]

Thanks OBP. I'm also a new NICU fellow, pretty nervous about starting clinical service. While I loved my residency program, it didn't give us as much NICU experience as some programs do, so I'm a little worried I'll be behind my attendings' expectations for a new fellow, and also a little behind the residents at my new institution. Any advice or thoughts?

 

[Tribeca]

Thank you, @oldbearprofessor! I figured I would initially do senior resident things (pre-charting and pre-rounding, knowing the sick babies, having a pulse on the unit). I worry about doing just enough on rounds to be an effective fellow (or to not fade into the background) but not step on Attending's toes.

Thanks OBP. I'm also a new NICU fellow, pretty nervous about starting clinical service. While I loved my residency program, it didn't give us as much NICU experience as some programs do, so I'm a little worried I'll be behind my attendings' expectations for a new fellow, and also a little behind the residents at my new institution. Any advice or thoughts?

Congrats, @NurWollen! From what I gathered from interviews and during bootcamp is that they know that not all residents have had the same exposure in NICU so they understand that and don't expect us to fully know everything. And I heard that that same feeling we got as interns when we felt that the MS4/sub-I knew more than us is what new fellows feel too -- that the senior residents know more.

Since I don't have any senior fellows to show me the ropes for EHR/unit processes what I've done is ask the residents about EHR stuff and where they look for info. The pharmacists and nutritionists have been a great resource too (and I feel I would get "less judged" by them as they are neither residents or Attendings).

Would love OBP's insight on this as well!

 

[oldbearprofessor]

Thanks OBP. I'm also a new NICU fellow, pretty nervous about starting clinical service. While I loved my residency program, it didn't give us as much NICU experience as some programs do, so I'm a little worried I'll be behind my attendings' expectations for a new fellow, and also a little behind the residents at my new institution. Any advice or thoughts?

The key thing that many new fellows lack these days is procedural skills. In residency it's hard currently to get a bunch of intubations, lines or chest tubes not to mention delivery room skills. So, focus on getting these experiences and making sure that you are the one to get them especially in the first 6 months. The other stuff will follow. Try to avoid being "competitive" with senior residents for info or to correct them on rounds. Unless really necessary save that for "off line". Pay attention to the dietitians and pharmacists as you'll pick up a lot of clues as to the "Way things are done here" that will be helpful on rounds. Ask for attending feedback regularly but don't be annoying about it. No news is usually good news in this context.

Also, try to be the one of the "first' to update the family whenever possible or at least make sure you're part of the conversation. This is important and a key fellow role and attendings will notice. As I've said before, I keep in touch with some families from my fellowship days in the 1980's via FB, etc and have watched several of those preemies become adults.

 

[oldbearprofessor]

By the way, I was only half joking about getting to know the person who empties the trash. Go out of your way to get to know folks like the radiology techs doing the films, the cleaning staff, the front desk person, etc and your life will be improved (you'll see why when they help you out on little things) and folks will notice. Most of all, you'll enjoy the experience more in the NICU if you know everyone there.

 

[Step Up]

Hi! I'm a new NICU fellow about to start service after two weeks of boot camp/orientation/shadowing rounds. I'll be in a unit with residents, med students, and NP's. This is a new fellowship so I am new to them too. What specific things should I be doing for rounds? I'm currently in "resident mode" and know exactly what to do as a resident but not exactly sure as a fellow.

I suggest re-framing your new role as "Pre-Attending Mode". Whenever a medical decision arises, consider what you would do if the attending was not there. How will you answer the question and address the issue. Ask your attending for help when appropriate, but always have your own thoughts first on how to deal with the situation. As you develop during fellowship, you will realize that more and more you can handle the situation without the attending, although having them there is oh so nice!

What should you do to prepare for rounds? Prepare as if you were the attending!

One pearl: if you find that you are overwhelmed in the morning preparing for rounds given the acuity or high census, or just because everything is so new to you, start your morning earlier! At least at the beginning of fellowship. An extra 30-60mins in the morning preparing will go a long way towards making you more comfortable in the unit.

 

[The Victors]

Does anyone have any recommendations for resources (textbook or otherwise) that they found particularly useful as a new 1st year fellow making the transition to a NICU fellowship?

 

[oldbearprofessor]

I'm biased towards Cloherty and Stark's Manual of Neonatal Care. Which reminds me my chapter for the next edition is due soon. Got to get to work. Lots of stuff you need day to day is in UptoDate.

 

[NurWollen]

I'm biased towards Cloherty and Stark's Manual of Neonatal Care. Which reminds me my chapter for the next edition is due soon. Got to get to work. Lots of stuff you need day to day is in UptoDate.

Love this book.

 

[Oso]

A little different, but any recommendations for a (hopefully) future fellow? I’ve read through Polin & Yoder’s workbook.

Definitely gonna try to study for boards this year, but do have some book money to spend and would like to spend some time focusing on NICU material as well.

Thanks!

 

[MLNS]

anyone have any good recommendations for books for residents? I’m not in neo but my SO is an intern, wants to do neo, and I’m not sure what to recommend to them to look at before/ during their first nicu rotation

they are very visual and historically haven’t done well with straight text books, if that helps narrow advice at all

thanks a lot and hope you don’t mind me dropping in!

 

[oldbearprofessor]

I haven't looked at this in a while, but I always used to like MacDonald's Atlas of Procedures in Neonatology (now in 6th edition). It's a bit specific to procedures but has lots of visuals of neonatal anatomy that are useful. Take a look on - line and see if this might fit the bill.

 

[Oso]

Thanks @oldbearprofessor !

@NurWollen do you have any reading recommendations for a 3rd year resident who wants to develop a decent neonatology foundation? I have read through Polin & Yoder’s workbook which I thought was good overall

 

[NurWollen]

Thanks @oldbearprofessor !

@NurWollen do you have any reading recommendations for a 3rd year resident who wants to develop a decent neonatology foundation? I have read through Polin & Yoder’s workbook which I thought was good overall

I never read Polin & Yoder's. Maybe I should have? I second OBP's recommendation above for Cloherty and Stark's Manual of Neonatal Care. It's succinct enough that you can read about any given topic in a reasonable amount of time and come away with a good understanding of the basics. For example if your attending tells you to read up on something in preparation for a teaching session, you can read up on that topic in this book in a reasonable amount of time but be well prepared for a discussion on that topic.

 

[Oso]

I never read Polin & Yoder's. Maybe I should have? I second OBP's recommendation above for Cloherty and Stark's Manual of Neonatal Care. It's succinct enough that you can read about any given topic in a reasonable amount of time and come away with a good understanding of the basics. For example if your attending tells you to read up on something in preparation for a teaching session, you can read up on that topic in this book in a reasonable amount of time but be well prepared for a discussion on that topic.

Sweet, thanks for the recommendation. Sounds like I definitely should take a look at this book!

 

[Tribeca]

I never read Polin & Yoder's. Maybe I should have? I second OBP's recommendation above for Cloherty and Stark's Manual of Neonatal Care. It's succinct enough that you can read about any given topic in a reasonable amount of time and come away with a good understanding of the basics. For example if your attending tells you to read up on something in preparation for a teaching session, you can read up on that topic in this book in a reasonable amount of time but be well prepared for a discussion on that topic.

How does the Cloherty & Stark compare to Gomella's? Is it similar information? Already have Gomella and not sure if I should get this in addition.

 

[Oso]

How does the Cloherty & Stark compare to Gomella's? Is it similar information? Already have Gomella and not sure if I should get this in addition.

I second this question

 

[hashimoto989]

Hi! I'm also a new first year NICU fellow, and have found this thread to be helpful! I will soon be starting my second month of service at our teaching hospital, so it'll be my first time working with residents and having more of a "fellow" role. It's a larger unit than where I did my first service month and I'll have more supervisory responsibility which I'm excited (and a bit nervous) for. Was wondering if anyone has tips on how they organize all the patients in the unit? Where I did residency, we had an EMR based handoff that was helpful for concisely having this information, but I don't have a similar system in my fellowship hospitals. Some fellows have suggested rounding type sheets for each patients, but the amount of papers becomes overwhelming and cumbersome. I tried making my own handoff type document during my last month but it was very time consuming to manually update all the info each day.

Any tips appreciated!

 

[NurWollen]

How does the Cloherty & Stark compare to Gomella's? Is it similar information? Already have Gomella and not sure if I should get this in addition.

You know, I honestly never used Gomella's in residency. I picked up a copy of Cloherty and Stark because one of my senior residents recommended it. I skimmed a copy of Gomella's that was in the bookshelf in the team room when I was on call the other night, and liked what I saw. I'd say Gomella's is probably a little bit more comprehensive, and Cloherty and Stark's is a bit more of a quick summary of a given topic. Cloherty and Stark's was perfect in residency whenever a neo attending would tell me "read about X and we'll talk about it tomorrow."

 

[mvenus929]

Hi! I'm also a new first year NICU fellow, and have found this thread to be helpful! I will soon be starting my second month of service at our teaching hospital, so it'll be my first time working with residents and having more of a "fellow" role. It's a larger unit than where I did my first service month and I'll have more supervisory responsibility which I'm excited (and a bit nervous) for. Was wondering if anyone has tips on how they organize all the patients in the unit? Where I did residency, we had an EMR based handoff that was helpful for concisely having this information, but I don't have a similar system in my fellowship hospitals. Some fellows have suggested rounding type sheets for each patients, but the amount of papers becomes overwhelming and cumbersome. I tried making my own handoff type document during my last month but it was very time consuming to manually update all the info each day.

Any tips appreciated!

Not sure if it would work well with NICU, but we have an Excel spreadsheet that we list our consults on. I save the document each morning to my iPad, and write notes on it throughout the day as we round, checking off boxes when I've followed up with teams, written notes, etc. If it's just for you (ours are shared), then you can potentially just update the numbers and such on rounds and write notes/erase when you finish tasks.

 

[BabyDoc86]

Thanks for this thread! Also a new fellow, and after having a few weeks call-free to study/take Boards, I'm excited but anxious to switch to our Level IV for the first time on Monday. This feels like being an intern all over again.